From the Russell H. Morgan Department of Radiology and Radiological Sciences (M.A.G., J.E., I.R.K., S.L.Z.) and Division of Cardiology (A.S.J.M.T.R., C.A.J., C.T., B.M., B.G.K., H.T., H.C.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Halsted B180, Baltimore, MD 21287; Division of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands (A.S.J.M.T.R.); Netherlands Heart Institute, Utrecht, the Netherlands (A.S.J.M.T.R.); and Department of Medicine/Cardiology, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Ind (H.S.V.C.).
Radiology. 2018 Dec;289(3):641-648. doi: 10.1148/radiol.2018180224. Epub 2018 Aug 21.
Purpose To compare epicardial fat in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) with that in healthy subjects. Materials and Methods In this retrospective study, cardiac CT scans in 44 patients with ARVD/C (mean age, 39 years ± 12; 23 men) were compared with those in 45 control group participants between January 2008 and July 2015. Volumes of intrathoracic adipose tissue, mediastinal adipose tissue (MAT), and total epicardial adipose tissue (EAT) were quantified. EAT was subdivided into three regions-right ventricular (RV) EAT, left ventricular (LV) EAT, and peri-atrial EAT (atrial EAT)-and normalized to MAT for all regions. Logistic regression and receiver operating characteristic analysis were performed to evaluate the association between epicardial fat with the diagnosis of ARVD/C. Results Total EAT volume was higher in patients with ARVD/C than in healthy control group participants (median, 98 mL vs 76 mL, respectively; P = .04). Regionally, LV and RV EAT volumes were higher in patients with ARVD/C than in control group participants, most notably when indexed to MAT (median LV EAT index: 0.49 vs 0.15, respectively; median RV EAT index: 0.91 vs 0.52; P ˂ .0005 for both). The optimal cutoff for diagnosis of ARVD/C was an LV EAT index of 0.24, with a sensitivity and specificity of 91% and 71%, respectively. Atrial EAT volume and total intrathoracic adipose tissue volume were not different between groups. RV diameter showed a positive correlation with total EAT index and LV EAT index (r = 0.21, P = .05 and r = 0.33, P = .002, respectively). Conclusion Higher amounts of right ventricular and left ventricular epicardial fat are found in hearts with arrhythmogenic right ventricular dysplasia/cardiomyopathy, particularly adjacent to the left ventricle, which correlates with disease severity and helps differentiate patients from healthy subjects. © RSNA, 2018 Online supplemental material is available for this article.
比较心律失常性右室心肌病（ARVD/C）患者与健康对照者的心外膜脂肪量。
本回顾性研究纳入了 2008 年 1 月至 2015 年 7 月期间的 44 例 ARVD/C 患者（平均年龄，39 岁±12 岁；23 名男性）和 45 例对照组参与者的心脏 CT 扫描结果。对胸腔内脂肪组织、纵隔脂肪组织（MAT）和总心外膜脂肪组织（EAT）体积进行了量化。EAT 分为 3 个区域：右心室（RV）EAT、左心室（LV）EAT 和心房周围 EAT（心房 EAT），并对所有区域进行了 MAT 归一化。采用 logistic 回归和受试者工作特征（ROC）曲线分析评估了心外膜脂肪与 ARVD/C 诊断之间的关系。
与健康对照组参与者相比，ARVD/C 患者的总 EAT 体积更高（中位数分别为 98ml 和 76ml，P =.04）。区域上，LV 和 RV EAT 体积在 ARVD/C 患者中高于对照组参与者，尤其是当以 MAT 进行指数化时（中位数 LV EAT 指数：0.49 比 0.15，中位数 RV EAT 指数：0.91 比 0.52；P 均＜.0005）。诊断 ARVD/C 的最佳截断值为 LV EAT 指数 0.24，其敏感性和特异性分别为 91%和 71%。两组间的心房 EAT 体积和总胸腔内脂肪组织体积无差异。RV 直径与总 EAT 指数和 LV EAT 指数呈正相关（r = 0.21，P =.05；r = 0.33，P =.002）。
心律失常性右室心肌病患者的右心室和左心室心外膜脂肪量较高，特别是紧邻左心室，这与疾病严重程度相关，并有助于将患者与健康对照者区分开来。
